Map of life expectancy at birth from Global Education Project.

Thursday, May 22, 2014

Les Izmore

A couple of interesting, or should I say egregious items in this week's medical journals. (You'll probably just get the abstracts, if that.)

Barnett and Linder proffer a research letter to JAMA which quite frankly baffles me. We have known for decades that antibiotics are not effective for acute bronchitis. CDC and others have been working to reduce antibiotic prescribing for acute bronchitis, and the leading quality measurement system, the Healthcare Effectiveness Data and Information Set metric is that antibiotic prescribing for acute bronchitis should be zero. Zip, zilch, nada. Don't do it, doc!

And yet, and yet . . . Based on the National Ambulatory Medical Care Survey and the hospital equivalent, which includes emergency departments, from 1996 to 2010 the rate of prescribing went up. It's nearly 80% -- that's right, 80% -- in primary care and about 70% in emergency departments. And physicians are prescribing broad spectrum antibiotics which are a) expensive and b) contributing widely to antibiotic resistance. Also, too, antibiotics are bad for you because they kill your symbiotic microflora. Why on earth is this happening? Beats the hell out of me.

Meanwhile, over at the New England Journal of Medicine, members of the Swiss Medical Board explain why they recommend abolishing routine mammographic screening. It seems that based on survey data, U.S. women estimate that if 1,000 women 50 to 60 are screened every year, deaths from breast cancer will be reduced from 160 to 80. Seems worth it, no?

Here's the cold truth. Based on the best available data, the actual reduction in breast cancer mortality would be from 5 to 4. And it's quite possible that the one death averted would be replaced by death from another cause. At the same time, "For every breast-cancer death prevented in U.S. women over a 10-year course of annual screening beginning at 50 years of age, 490 to 670 women are likely to have a false positive mammogram with repeat examination; 70 to 100, an unnecessary biopsy; and 3 to 14, an overdiagnosed breast cancer that would never have become clinically apparent." "Overdiagnosed breast cancer" likely means surgery, radiation, chemotherapy, and terror. Maybe not so worth it?

Any time somebody makes an assertion of this nature, screaming vengeful hordes descend upon them, accusing them of not valuing women's lives and basically committing murder and mayhem. Oncologists and surgeons and radiologists and drug companies make big bucks off of this. But women should make up their own minds.

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jenniffer said...
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